Apply for AHCIP
- Application form for AHCIP Coverage
- Application form for AHCIP Coverage: Canadian Children of Non-Eligible Parents – Use only for your Canadian child if you are the child’s parent, you have established residency in Alberta, and you, the parent, are not eligible for AHCIP coverage.
PDF form issues
Fillable PDF forms do not open properly on some mobile devices and web browsers. To fill in and save the form:
- Save the PDF form to your computer – click or right-click the link and download the form.
- Open the PDF form with Adobe Reader. Fill it in and save it.
If you are still having problems opening the form, contact PDF form technical support.
Download, complete and print the appropriate form. Do not send any information or forms by email.
Submit your application. You can:
Blue Cross benefit forms
Alberta Blue Cross administers supplementary benefit plans on behalf of the Government of Alberta.
- Proof of Age for Alberta Senior Benefit Program
- Application for Alberta Blue Cross Non-group Coverage
- Application for Premium Subsidy for Non-Group Premiums
- Current and Retroactive Premium Subsidy
- Registration for Preauthorized Monthly Payment for Non-Group Premiums
- Alberta Blue Cross Health Services Claim form (PDF, 158 KB)
- Palliative Coverage Program form
If you have questions about benefit forms, contact Alberta Blue Cross.
Find out how to claim for benefits through Alberta Blue Cross.
Statement of Benefits Paid
A Statement of Benefits Paid (SOBP) is a list of physician services paid for by the AHCIP on your behalf during a specific period. It includes the date and general type of service, physician name and the amount that was paid to the physician.
The requested SOBP is sent directly to the individual or their authorized representative.
Hospital services do not appear on the SOBP. These may be requested directly from the hospital.
How to order an SOBP
There is no cost for an SOBP for the most recent benefit year (July 1 to June 30) to the current year to date.
To request a current SOBP, download and complete the Request for Statement of Benefits Paid form (PDF, 156 KB) and mail the completed form to the AHCIP office.
Or, place an order using the automated phone system:
An SOBP can be requested back to October 1, 1993. There is a fee of $25 plus GST ($26.25) per request for individuals ordering a personal SOBP directly.
Families ordering for more than one person on the same AHCIP account pay only $26.25 for everyone.
To request an SOBP from previous years:
- Download and compete the Request for Statement of Benefits Paid form (PDF, 156 KB).
- Mail the completed form with your payment. Only cheques or money orders are accepted, payable to 'Government of Alberta.'
If a third-party such as a law firm or insurance company wishes to request an SOBP on behalf of an Albertan, contact Alberta Health by emailing [email protected] as you will need a specific consent form not available on this web page (AHC2099).
The fee for third-party SOBP requests is $75 ($78.75 with GST).
Contact us if you need help, or are from a law firm or insurance company requiring this statement.
Office hours: 8:15 am to 4:30 pm, Monday to Friday, excluding holidays
Email: [email protected]
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